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Oudbier SJ, Souget-Ruff SP, Chen BSJ, Ziesemer KA, Meij HJ, Smets EMA. Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews. BMJ Open 2024; 14:e075833. [PMID: 38858155 PMCID: PMC11168143 DOI: 10.1136/bmjopen-2023-075833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs. DESIGN Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline. ELIGIBILITY CRITERIA Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal. DATA EXTRACTION AND SYNTHESIS Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators. RESULTS Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33). CONCLUSIONS The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
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Affiliation(s)
- Susan J Oudbier
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Digital Health, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
| | - Sylvie P Souget-Ruff
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Britney S J Chen
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Kirsten A Ziesemer
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hans J Meij
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Personalized Medicine, Amsterdam, The Netherlands
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Burke C, Rossitch SS, Bejarano G, Knisely M, Ford CG, Allen KD, Ma J, Blalock DV, Ear B, Cantrell S, Gordon AM, Van Voorhees E, Goldstein KM, Williams JW, Gierisch JM. Videoconferencing of Movement-Based and Psychologically Informed Interventions for Chronic Pain: A Systematic Review and Horizon Scan. Telemed J E Health 2023; 29:1275-1288. [PMID: 36787486 DOI: 10.1089/tmj.2022.0308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Introduction: With the coronavirus disease 2019 (COVID-19) pandemic, use of telehealth technology increased dramatically. Nonpharmacological approaches to pain management may be well suited for virtual care. Yet, it is not widely understood if this treatment modality is effective when delivered via videoconferencing. This review examines the effectiveness of movement-based and psychologically informed chronic pain management interventions delivered via videoconferencing compared to in-person care. Methods: Searches of MEDLINE® (via Ovid®), Embase (via Elsevier), CINAHL Complete (via EBSCO), and Cochrane Central Register of Controlled Trials (via Ovid) were performed from inception to June 10, 2021. All articles meeting eligibility criteria were included for data abstraction. Results: Eight thousand two hundred fifty-two citations were identified, and after removing duplicates, 4,661 citations remained. One study investigating acceptance and commitment therapy met eligibility criteria. The noninferiority randomized trial found no statistically significant difference in outcomes between delivery modalities. A horizon scan was conducted to assess planned or recent studies. Horizon scan results yielded six protocols in trial databases, one pilot study, and three published protocols for ongoing studies. Discussion: Findings from this study indicate that virtually delivered pain management is a possible substitute for in-person care. Given the paucity of evidence on this topic, further comparative and adequately powered studies that assess the impact of movement-based and psychologically informed pain management delivered via videoconferencing are needed. Conclusions: Research is needed to understand patient preferences of such interventions within a variety of settings. Such evaluations will be needed to guide clinical and operations practice to optimize equitable deployment and access to high-quality health care delivered via videoconferencing.
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Affiliation(s)
- Colleen Burke
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Stephanie Salcedo Rossitch
- Mental and Behavioral Health Service Line, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Geronimo Bejarano
- Department of Epidemiology, The University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Mitchell Knisely
- Healthcare in Adult Populations Division of the Duke University School of Nursing, Durham, North Carolina, USA
| | - Christopher Graham Ford
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kelli D Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Jessica Ma
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, NC
| | - Dan V Blalock
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Belinda Ear
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Sarah Cantrell
- Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, North Carolina, USA
| | - Adelaide M Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Elizabeth Van Voorhees
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VISN-6 Mental Ilness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - John W Williams
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jennifer M Gierisch
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
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Azari L, Turner K, Hong YR, Alishahi Tabriz A. Adoption of emergency department crowding interventions among US hospitals between 2007 and 2020. Am J Emerg Med 2023; 70:127-132. [PMID: 37270852 DOI: 10.1016/j.ajem.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 05/03/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND To deal with emergency department (ED) crowding, the American College of Emergency Physicians (ACEP) established a task force to develop a list of low-cost, high-impact solutions. In this study, we report on the trend in the adoption rate of ACEP-recommended ED crowding interventions by US hospitals. METHODS We analyzed the National Hospital Ambulatory Medical Care Survey data from 2007 to 2020 (N = 3874 hospitals). The primary outcome was whether a hospital adopted each of the ACEP-recommended interventions, which were grouped into three overlapping categories: technology-based, flow modifications, and physical-based (e.g., changing ED layout). RESULTS On average, the most frequently adopted intervention was bedside registration (85.1%) and the least frequently adopted intervention was kiosk check-in (8.3%). The adoption of ED crowding interventions increased significantly between 2007 and 2020, except for expanding ED treatment space which declined by 45.0% from 30.3% in 2007 to 15.7% in 2020. The largest adoption rate increase occurred in having a separate operating room for ED cases with a 188.5% increase in adoption rate followed by radio-frequency identification (RFID) tracking (151.2%), and kiosk check-in (144.2%). CONCLUSIONS The adoption rate of ED crowding interventions by hospitals has risen, however most effective ED crowding interventions are still underutilized. The trends for each intervention did not always increase linearly, with certain periods showing greater fluctuations in adoption rate. Hospitals tend to implement technology-based interventions, compared to physical-based interventions and flow modification interventions.
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Affiliation(s)
- Leila Azari
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions University of Florida, Gainesville, FL, USA; UF Health Cancer Center, Gainesville, FL, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Shinners L, Grace S, Smith S, Stephens A, Aggar C. Exploring healthcare professionals' perceptions of artificial intelligence: Piloting the Shinners Artificial Intelligence Perception tool. Digit Health 2022; 8:20552076221078110. [PMID: 35154807 PMCID: PMC8832586 DOI: 10.1177/20552076221078110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/18/2022] [Indexed: 12/31/2022] Open
Abstract
Objective There is an urgent need to prepare the healthcare workforce for the
implementation of artificial intelligence (AI) into the healthcare setting.
Insights into workforce perception of AI could identify potential challenges
that an organisation may face when implementing this new technology. The aim
of this study was to psychometrically evaluate and pilot the Shinners
Artificial Intelligence Perception (SHAIP) questionnaire that is designed to
explore healthcare professionals’ perceptions of AI. Instrument validation
was achieved through a cross-sectional study of healthcare professionals
(n = 252) from a regional health district in
Australia. Methods and Results Exploratory factor analysis was conducted and analysis yielded a two-factor
solution consisting of 10 items and explained 51.7% of the total variance.
Factor one represented perceptions of ‘Professional impact of
AI’ (α = .832) and Factor two represented ‘Preparedness
for AI’ (α = .632). An analysis of variance indicated that ‘use
of AI’ had a significant effect on healthcare professionals’ perceptions of
both factors. ‘Discipline’ had a significant effect on Allied Health
professionals’ perception of Factor one and low mean scale score across all
disciplines suggests that all disciplines perceive that they are not
prepared for AI. Conclusions The results of this study provide preliminary support for the SHAIP tool and
a two-factor solution that measures healthcare professionals’ perceptions of
AI. Further testing is needed to establish the reliability or re-modelling
of Factor 2 and the overall performance of the SHAIP tool as a global
instrument.
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Affiliation(s)
- Lucy Shinners
- (Faculty of Health), Southern Cross University, Australia
| | - Sandra Grace
- (Faculty of Health), Southern Cross University, Australia
| | - Stuart Smith
- (Faculty of Health), Southern Cross University, Australia
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Alishahi Tabriz A, Turner K, Williams D, Babu N, North S, Shea CM. Association of Financial Factors and Telemedicine Adoption for Heart Attack and Stroke Care Among Rural and Urban Hospitals: A Longitudinal Study. Telemed J E Health 2021; 28:781-788. [PMID: 34559014 DOI: 10.1089/tmj.2021.0341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: To examine trends in telemedicine adoption for stroke and cardiac care among U.S. hospitals, specifically associations between hospital financial indicators and adoption of these telemedicine services. Methods: This is a retrospective analysis of data from the Health Information Management and System Society Dorenfest Database and Healthcare Cost Report Information System from 2012 to 2017. We used a pooled ordinary least squares model and reported results as average marginal effects (AMEs). Results: The number of hospitals with stroke or cardiac telemedicine services in urban and rural areas increased through our study period from 153 (7.30%) to 407 (19.42%) and from 127 (6.31%) to 331 (16.45%), respectively. In rural hospitals, being a for-profit hospital (AME = -10.49, 95% confidence interval [CI] = -14.01 to -6.98) and having an increase in Medicare inpatient mix (AME = -0.31, 95% CI = -0.42 to -0.20) were associated with the probability of telemedicine adoption for heart attack and stroke care. A couple of nonfinancial variables included in the model also were associated with adoption, specifically having one more licensed bed (AME = -0.02, 95% CI = -0.04 to -0.00) and higher number of emergency department visits (AME = 5.64, 95% CI = 2.83 to 7.20). In urban hospitals, being a for-profit hospital (AME = -8.94, 95% CI = -11.76 to -6.11) and having a higher total margin (AME = 0.17, 95% CI = 0.08 to 0.26) were associated with the probability of telemedicine adoption for heart attack and stroke care. Two nonfinancial variables also were statistically significant: having one more licensed bed (AME = 0.01, 95% CI = 0.041 to 0.02) and being closer to another telemedicine hospital (AME = 0.81, 95% CI = -1.62 to 0.01). Discussions: Telemedicine adoption rate for cardiac and stroke care has increased significantly in recent years. Financial status may be a bigger driver of adoption for urban hospitals than rural hospitals.
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Affiliation(s)
- Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Dunc Williams
- Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nimmy Babu
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina, USA
| | - Christopher M Shea
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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Sundberg A, Wahlberg AC, Zethraeus N, Karampampa K. Observational study of the implementation of telephone advice nursing in Sweden: did callers follow recommendations and did the rate of healthcare visits change? BMJ Open 2021; 11:e051233. [PMID: 34413110 PMCID: PMC8378364 DOI: 10.1136/bmjopen-2021-051233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Telephone advice nursing is introduced in many countries with one key aim being a reduction of avoidable healthcare visits. The aim of this study was to explore whether callers to a telephone advice nursing service followed the telenurses' recommendations, and whether there was a change in the level and trend of the rate of healthcare visits after the introduction of telephone advice nursing. DESIGN Observational study. SETTING Primary and secondary care in Jönköping Region, Sweden. PARTICIPANTS Telephone advice nursing calls, 6:00-23:00, 2014-2015 (n=185 994) and outpatient healthcare visits 2012-2015 (n=6 877 266). PRIMARY OUTCOME Proportion of callers who visited healthcare within the time period advised by the telenurse. SECONDARY OUTCOME Change in level or trend of the overall rate of healthcare visits per 1000 persons and 4-week period after the introduction of telephone advice nursing, with subgroup analysis for primary and secondary care. RESULTS 77% of callers who were recommended either to visit healthcare within 24 hours or to 'wait and see' followed the recommendations. There was no significant change in level (-5.15; 95% CI -15.80 to 5.50; p=0.349) or trend (-0.24; 95% CI -0.86 to 0.38; p=0.448) of the overall rate of visits per 1000 persons and 4-week period after the introduction of telephone advice nursing. For the rate of primary care visits, an increase in level (8.01; 95% CI 6.36 to 9.66; p<0.001) and trend (1.28; 95% CI 1.17 to 1.39; p<0.001) were observed. For the rate of secondary care visits, a decrease in level (-8.77, 95% CI -14.41 to -3.13; p=0.004) and trend (-1.03, 95% CI -1.35 to -0.71; p<0.001) were observed. CONCLUSIONS The introduction of telephone advice nursing may have contributed to a shift in the rate of healthcare visits from secondary to primary care.
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Affiliation(s)
- Amanda Sundberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Carin Wahlberg
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Zethraeus
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Korinna Karampampa
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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